A Kaiser doctor had ordered 16 hours of home health care each day, but the health plan authorized only eight hours a day, said Daniel Zingale, director of the department. The DMHC's independent medical review order found the patient, a Fairfield man with Lou Gehrig's disease, should have 12 hours a day of in-home health care, he said.
For a year after the review, Kaiser failed to provide that care, Zingale said.
An independent medical review order by the department is "sacrosanct, the core of the Patient's Bill of Rights," he said.
"We not only found the problem in this case, but we also found a pattern when we surveyed their home health system," Zingale said.
Under the agreement with Kaiser, the health plan will pay $100,000 and create a system to improve tracking of home health care, he said.
Kaiser's media relations director Tom Debley said the new monitoring system would increase the health plan's oversight of the home health services businesses with which it contracts.
"Basically, there were times when fewer hours were provided, sometimes due to unavailability of the contract staff," Debley said.
Zingale said he was encouraged the health plan had agreed to pay the fine and better monitor to ensure that independent medical reviews were followed.
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